Top 5 Issues With PCS Forms
And How To Avoid Them
By: Samuel Scheller, MBA, NRP
The Physician Certification Statement (or PCS form) is used by ambulance companies throughout the country to demonstrate medical necessity for ambulance transportation. In other words, the PCS form is used to describe why an ambulance was used to transport a patient versus other, cheaper alternatives including a wheelchair service, taxi cab, or public transportation. Medicare requires this form to be filled out by certain hospital staff members when the patient is being transported by ambulance from a higher level of care to a lower level of care or to an equal level of care. An incorrectly filled out PCS form may lead to Medicare or other insurances denying the ambulance claim and leaving your facility as payer of last resort. Avoided these five mistakes to ensure that this does not happen to your facility.
1) The biggest problem that ambulance companies face with PCS forms is hospital staff not signing the bottom of the document. A PCS form must be signed in order for it to be considered valid. In addition, a PCS form is only valid if the form is signed by a Physician, Registered Nurse, Discharge Planner, Nurse Practitioner, Physician Assistant, or a Clinical Nurse Specialist. Certified Nursing Assistants, EMS personnel, social workers, and transportation coordinators are not allowed to sign a PCS form.
2) Often times a patient is being sent from one hospital to another because the sending hospital does not have the proper services or resources to address the patient’s needs. Therefore if the patient is being sent to another hospital because of lack of services or resources, then the services or resources that are not available at the sending facility need to be listed on the PCS form. For example, a hospital that does not have a CT scanner or Gastroenterology services would list those as a service that is not available.
3) When a patient is transported by ambulance there needs to be some kind of medical necessity as to why the ambulance was used versus other forms of transportation such as a taxi, public transportation, or a wheelchair service. A well written PCS form will clearly articulate the medical necessity as to why the ambulance had to be used. This can be documented by either describing why the patient is unable to sit or travel in a wheel chair or by using the checkboxes to define medical reasons for the ambulance. When the checkboxes are used then they need to be explained below in the appropriate space.
4) A common reason for an incomplete PCS form is the lack of patient demographics including the patient’s name and date of birth. Other importation information includes the date of the transport, the sending facility, the receiving facility, and the physician seeing the patient. In addition a phone number and fax number for the sending facility is important incase the ambulance company has questions about the PCS form or needs revisions made.
5) Lastly, a PCS form may be denied by insurances because it is illegible and not clear to read. As healthcare providers, our handwriting is often times not the best, however a PCS form is not a form to rush through! A PCS form should be clearly written to ensure that it is legible and clearly articulates the reason for the ambulance transfer. An illegible PCS form can lead to insurance denying the ambulance transport and your facility being stuck as payer of last resort.
Added Tip: EMS crews are not supposed to fill out the PCS form, otherwise it is considered Medicare fraud! This form must be filled out by the hospital staff.
PCS Form Frequently Asked Questions
Q: The patient has private insurance, does a PCS form need to be filled out?
A: Medicare is the only insurance provider that requires a PCS form to submit a claim, however a PCS form can be used for any insurance company to define medical necessity for ambulance transportation. Ambulance companies may request a PCS form regardless of the insurance type in case insurance denies the claim there is supporting documentation to explain the reason for ambulance transfer.
Q: I called 911 to have a patient transported by ambulance to an Emergency Room. Does a PCS form need to be filled out?
A: In most cases this would be seen as a transfer to a higher level of care. In this case a PCS form does not need to be filled out.
Q: The patient does not meet the criteria listed on the PCS form. Can an ambulance still transport the patient?
A: Yes, an ambulance can still transport the patient, however the patient or the facility might be stuck with the bill. If the patient does not meet the criteria on the PCS form, then consider an alternative method of transportation.
To download a PCS form visit us at online at https://lasvegasambulance.com/pcs.pdf. After your PCS form is filled out and complete, it can be faxed to 702-207-0599. If you have any questions about the PCS form or to arrange for ambulance transportation, call our 24 hour ambulance dispatch center at 702-GEMS-911 (702-436-7911).
About Guardian Elite Medical Servivces
Guardian Elite Medical Services is an ambulance service that provides ambulance transportation to the City of Las Vegas, Boulder City, and all federal facilities. Our motto, “People Taking Care of People,” reflects our mission to simply take care of people. Guardian Elite Medical Services is owned by local Paramedic Samuel Scheller.